<extend name="_Layout/maintwo"/>
<block name="contacts">
        <!--CONTENT-->
        <section class="content">
            <h1>
                联系信息                </h1>
            <div class="registration">
                <form id="contact_form" action="." method="post" onsubmit="javascript:return false;">
                    <input type="hidden" name="site_id" value="13"/>
                    <div class="line">
                        <div class="left"><label>主题*:</label></div>
                        <div class="right">
                            <select class="feedback_themes" name="theme">
                                <option value="0" disabled="disabled" selected="selected">选择主题</option>
                                <option value="i_am_newcomer">这里我是新人。联系我。</option>
                                <option value="edit_phone">在用户中心里我想改变我的手机号码</option>
                                <option value="appeal_to_administration">给管理人员信</option>
                            </select>
                        </div>
                    </div>
                    <div class="line">
                        <div class="left"><label>短信*:</label></div>
                        <div class="right"><textarea name="message"></textarea></div>
                    </div>
                    <div class="line">
                        <div class="left"><label>您的名字*:</label></div>
                        <div class="right"><input name="name" type="text"/></div>
                    </div>
                    <div class="line">
                        <div class="left"><label>状态:</label></div>
                        <div class="right">
                            <select name="isMember">
                                <option value="0">我不是会员</option>
                                <option value="1">我是会员</option>
                            </select>
                        </div>
                    </div>
                    <div class="line">
                        <div class="left"><label>电话号码:</label></div>
                        <div class="right"><input name="phone" type="text" /></div>
                    </div>
                    <div class="line">
                        <div class="left">
                            <label>邮箱*:</label>
                            <p>您的“回复”邮箱</p>
                        </div>
                        <div class="right"><input name="email" type="text" /></div>
                    </div>
                    <div class="line">
                        <div class="left"><label>Skype:</label></div>
                        <div class="right"><input name="skype" type="text"/></div>
                    </div>
                    <div class="line">
                        <div class="left"><label id="captcha-code-label">图像编码*:</label></div>
                        <div class="right">
                            <input type="text" maxlength="5" pattern="\d{5}" id="captcha-input-field" name="captcha_code">
                            <canvas id="reg-canvas" width="100" height="50" style="width: 200px;"></canvas>
                            <p>
                                <a href="#" id="captcha-reload-element">
                                    更新						</a>
                            </p>
                        </div>
                    </div>
                    <div class="line">
                        <div class="left"></div>
                        <div class="right">字段有标*需要被填补。</div>
                    </div>
                    <div class="line">
                        <div class="left"></div>
                        <div class="right" data-form-errors-container="">

                        </div>
                    </div>
                    <div class="line">
                        <div class="left"></div>
                        <div class="right">
                            <button type="submit" class="send_but">提交</button>
                        </div>
                    </div>
                </form>
            </div>
            <script data-cfasync="false">window.REGISTRATION_ONAPI_URL_PREFIX = '/ajax/onapi';</script>
        </section>
        <!--/CONTENT-->

    </div>
    <div class="footer_push"></div>
</div>
</block>